title: Is the double-guidewire technique superior to the pancreatic duct guidewire technique in cases of pancreatic duct opacification?
abstract: OBJECTIVE
  Pancreatic duct guidewire placement (P-GW) techniques include both the injection cannulation technique with a contrast medium and wire-guided cannulation without contrast injection for selective biliary cannulation; the latter is the so-called "double-guidewire technique" (D-GW). The aim of this study was to compare the outcomes between P-GW and D-GW for biliary cannulation.
  
  
  METHODS
  The procedures for biliary cannulation with a naïve papilla were performed in a total of 363 cases. We divided the patients chronologically, according to the time period during which the procedures were performed, into two groups: group A, P-GW performed from March 2008 to June 2009; and group B, D-GW performed from July 2009 to December 2010. The success rates and complication rates were evaluated in each group.
  
  
  RESULTS
  Biliary cannulation was successful in 31 (81.6%) patients in the P-GW group and 34 patients (82.9%) in the D-GW group. The onsets of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) occurred in the P-GW and D-GW groups were four (10.5%) and three (7.3%) patients, respectively, and all were mild cases (P = 0.616). The frequency of hyperamylasemia and the serum amylase level tended to be lower in the D-GW group than in the P-GW group (P = 0.213). There was a statistically significant difference on the onsets of PEP in the GW and non-GW groups (P = 0.04, 8.9% and 1.1%, respectively).
  
  
  CONCLUSIONS
  Both the D-GW and P-GW techniques were equally effective for difficult biliary cannulation. Furthermore, the complication rates, including PEP, were similar in both techniques. A prospective randomized trial is warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Reina
authors.initials: R
authors.lastname: Tanaka
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Shujiro
authors.initials: S
authors.lastname: Tsuji
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ikeuchi
authors.forename: Junko
authors.initials: J
authors.lastname: Umeda
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tonozuka
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Honjo
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Mukai
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D020698:Duodenoscopes; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: cannulation; double-guidewire technique; endoscopic retrograde cholangiopancreatography; guidewire technique; pancreatic duct; post-ERCP pancreatitis